What I wish I knew before entering Emergency Services- Kevin Mazza

Hey.

Got a minute? There’s something we should talk about.

Thinking about becoming a medic? EMT? Nurse? Doctor? Thinking about giving your life to the service of others, namely, in their darkest hour as an emergency provider? It sounds noble, and it certainly is; and, it feels damn good too. Well, it feels good sometimes. There are some things they don’t tell you in class before you begin. My fellow Overrun team members will tell you about what they think they should have been told before becoming a medic or nurse. I’m going to tell you what I wish I was told before getting into emergency services. 

First, let’s do some background. I’m usually a private person and I don’t normally divulge details of my personal life. I never thought about being in medicine. I knew I wanted study science, this much is true; but, medicine was the last thing I thought about. For the sake of brevity, I will provide a brief history of how I found my way here. My first experience with a group that serves others in dire need was in college. My (first) college had a unique program, Eckerd College Search and Rescue (EC-SAR). I got to train and ride around the Boca Raton Bay in St. Petersburg, Florida on a rescue boat. We primarily towed boats who ran out gas or broke down. Every once in a rare while, we would assist the US Coast Guard searching for a missing person or a jumper from the Sunshine Skyway. It was thrilling and I was hooked. I continued to study Marine Geology (so interesting, I know) with full intentions of becoming a volcanologist or seismologist. After some soul searching, I decided it wasn’t for me. It didn’t believe I would be fulfilled. 

Fast forward a few years (and a few majors at a few colleges), I was lost. I didn’t know what I wanted to be when I grew up. I was working retail at a big box home improvement store. I lost that job and needed work. My childhood best friend recommended joining the local first aid squad. They would pay for training and I could work in the field while studying for whatever I wanted to be while doing it. From day one, I was in love with medicine. I was endlessly fascinated with it. After witnessing my first intubation, I knew I wanted to be a medic. Just three months after EMT school, I applied to paramedic school and was somehow accepted. After 9 years in the field, I have learned some things, and have some thoughts that I would like to impart upon you.

Wow, that was quite a journey. You know me so well that we could be family! Thanksgiving at your place, and you should know that I refuse to be in the same room as a crustacean. Plan accordingly. 

Here is what I wish was told to me on my first day of EMT school:

You have chosen to bear witness to your fellow humans their most vulnerable. Everything you witness will stay with you in some way. Every single critically ill or injured person will impact you, whether you know it or not. Every screaming mother who watches you perform CPR on her child, every burned trauma from a car accident, every crying new widow(er), every moment of your patient’s emotional and physical pain will affect you in some way. But those are obvious right? It’s the routine chest pains and broken legs that will add up. Like pennies in a jar over years, you end up collecting a few dollars of grief and pain. 

This job will come home with you. Whether you carry it or it follows you like a shadow, it will be there. We are grief mops, soaking up the suffering of those around us, because that’s what the job demands we do. If you cannot handle that, this career field isn’t for you. If you do not feel for your patients, this job is DEFINITELY NOT for you. 

A recent partner imparted some knowledge on me:

“Empathy is a requirement, sympathy is the price we pay.”

Let’s dissect that statement here. Empathy, specifically affective empathy, is what we need to possess in order to properly and completely care for out patients. “’Affective empathy’ refers to the sensations and feelings we get in response to others’ emotions; this can include mirroring what that person is feeling, or just feeling stressed when we detect another’s fear or anxiety.” In order to treat the whole patient, and not just the monitor, we need to be able to sense their pain, fears, and anxiety. They teach this in nursing school, often called a holistic approach, and it’s something we do not do a good job teaching pre-hospital providers.

Sympathy is related, but different. Sympathy is defined according to Merriam-Webster, as: “an affinity, association, or relationship between persons or things wherein whatever affects one similarly affects the other.” The bridge from empathy to sympathy is compassion. 

You may be thinking, how come I don’t cry with my patients if I’m experiencing sympathy? We get though these feelings in the moment by de-humanizing our patients. It’s not Mrs. Womansfield having chest pain; it’s a 72 year old female with acute coronary symptoms. It’s not Brett experiencing a losing battle against opioid addiction. It’s a 22 year old male who needs overdosed on heroin, needs Narcan, and, apparently, the consternation of his EMS providers (we will get into how messed up that is another time). But those feelings are there and they take their toll over time.

Let’s now tie it together. We need empathy in order to understand our patient’s feelings. Compassion is the bridge we take to reach sympathy. Sympathy means that their pain is our pain, their fear is our fear, their anxiety is our anxiety. I don’t believe you choose to cross that bridge, but your evolutionary programming as a social animal carries you across that bridge like one of those motorized walkways at the airport terminal. My next statement is the best advice I can give.

DO NOT FIGHT IT.

Here’s why. You will lose, and you will bottle all of this up inside of you. It becomes a dark cloud over ever minute of your life. You will start replaying your “failures,” over and over and over again in your mind. You’ll lose sleep, develop unhealthy coping mechanisms, and even begin to take steps toward the darkest of thoughts: suicide.

This is called burnout and it is very real. We have a problem with suicide amongst first responders: EMS, fire, and police.

I can tell you this, because I have been there. I have never gotten to thinking of taking my own life, but that’s because I made it to therapy first and saw a doctor. I got help. 

Wow, this got dark quick. Quick! Click this!Ok, that was a good five minute break, stranger on the internet.

I’m sorry that I’m not sorry, because this needs to be known to those who look to enter this field.

So, what can be done to stymie this? It’s not too hard if you can get ahead of it. First, and foremost is to have an understanding support system. Family, friends, and partners and exactly who I am talking about. They may not understand the things we see and feel, but telling them helps us offload that burden.  

Your co-workers, with whom you are friendly, may be the best resource though. They know what you are feeling and they feel it too. They may be able to help you overcome your feelings. But we need a culture shift in order to ensure that this is a realistic option.

You know exactly what I’m talking about.

“Suck it up, buttercup.”

“Don’t be such a pussy.”

“This is the job. You can always quit if you can’t handle it.” 

We have a disgusting culture of suppressing emotion in a field that requires emotion to be effective; again, a topic for another time.

So, do you still want the job? Good because we need you and we need you to be ready to deal with the unspoken toll this job will take on your metaphorical soul.